Sunday 1 August 2010 15.11 EDT
First published on Sunday 1 August 2010 15.11 EDT

Anne Milton is more than welcome to call me fat – I prefer it to obese, in fact. I have a body mass index of around 34 and wear a size 18-20 (UK), so I've certainly heard both before. But, despite the health minister's belief that hearing the word fat from doctors would be a wake-up call to folks my size, I'm personally not fazed by the F-word at all.

I'm not every fat woman, though; as the co-author of a book about fat acceptance, I'm deliberately reclaiming the word. I use it casually and unabashedly because I'd like to see its meaning changed, eventually, from something with hostile and humiliating connotations to neutral ones (I won't hold my breath for positive). And in the meantime, its power to wound, to shame, to dehumanise people remains fierce as ever. And, as far as I can tell, that's why Milton thinks physicians should use it.

"If I look in the mirror and think I am obese, I think I am less worried than if I think I am fat," Milton told the BBC. Having seen pictures of her, I'd say that if Milton looks in the mirror and sees someone fat or obese, she ought to see a specialist in body dysmorphic disorder, so one presumes she's just guessing at how she would feel if she were a person with a BMI over 30. Milton believes that fat would be more concerning to her – even though it's a word so broadly defined as to be a favourite putdown of online commentators who have never laid eyes on each other, third-rate awards-show gag writers and lithe teenage girls who feel guilty about eating a single chocolate. Obesity, on the other hand, is the medical term for a condition that is correlated with type 2 diabetes, heart disease, depression, joint pain and a grave risk of one day seeing your body illustrating an article about all of the above. How can fat be perceived as a more powerful agent of worry than that?

Fat is still a feature of the language of shame – of the playground bully, of the vengeful ex, of the disapproving parent. Obese is a word the medical community and media have done a bang-up job of intertwining with fears of disability and mortality, but "fat" is intertwined with something far worse – the fear that, while you remain on this earth, not yet claimed by the gruesome obesity-related illness that surely awaits, you will not be loved. And it's all your fault, fatty.

Milton thinks that's the word doctors should be using with their patients. The spectre of illness and death hasn't been enough to turn fat people thin, so it is time to haul out the big guns. It is time for physicians to start using a word that means so much more than "There are serious risks you need to be aware of, sir" – a word that means, among other things: lazy, ugly, gluttonous, rude, careless.

Believe me, I would love to live in a culture where fat merely means "having more adipose tissue than average", and in which that implies nothing about one's character. That's why I shamelessly call myself fat, no matter how many people insist that both the word and my body demand some measure of embarrassment and apology. But it's going to be a long while before fat is used in that value-neutral sense, and in the meantime we all know exactly what most people mean by it: you are disgusting, worthless, not quite human.

If the health secretary truly believes that this is an appropriate way for physicians to speak to their patients, I'd recommend that she take another look in the mirror and ponder whether hateful or foolish is the more worrisome adjective to her ears.